Senator Chuck Grassley (R-Iowa) has relentlessly pursued fraud, protectionism, price gouging, and other ethical violations in pharmaceutical and medical device marketing practices. Grassley is the only Republican member of Congress who supports intensified regulation in the health industries. Yet he was an outspoken critic of Obamacare, despite the president’s hopes to recruit him to the cause, and drug companies are among his largest campaign contributors. What moves Grassley on this issue? The answer may prove key because all political parties agree that cutting health care costs is central to balancing the US budget, yet no across-the-board measures can be implemented without conservative support. Grassley appears to hold an idiosyncratic viewpoint. In the end, Grassley’s ability and willingness to hold big pharma and the medical industry to account—to force them to accurately report the efficacy and cost effectiveness of their drugs and devices—may be critical to the success or failure of Obama’s struggling health care initiative.

There are many startling examples of Grassley holding Big Pharma’s feet to the fire. Once came a few years ago after his staff’s investigation uncovered examples of GlaxoSmithKline manipulating and withholding data from the FDA.

“It looks like GlaxoSmithKline bamboozled the FDA,” Grassley said in a speech on the floor of the senate. “We cannot live in a nation where drug companies are less than candid, hide information and attempt to mislead the FDA and the public.”

The hearings resulted in the 2010 passage of the Physician Payments Sunshine Act, written by Grassley and Herb Kohl (D-Wisconsin), requiring drug and medical device manufacturers to report gifts and payments made to physicians and teaching hospitals.

He’s more than willing to go after even his biggest contributors.

In May 2007, in his capacity as Chairman of the Senate Finance Committee, Grassley sent a threatening letter to Amgen Inc., manufacturer of several blockbuster anemia drugs used in chemotherapy for cancer patients. “I read with great concern that Amgen Inc. was not being up front about all the drug’s risks. What further troubled me was a [report] that the FDA was given limited access to results from company studies…”

According to OpenSecrets.org, Amgen Inc. was the second leading contributor to Grassley’s campaign for reelection between 2005 and 2010, topped only by the contributions from the health insurer, Blue Cross/Blue Shield. In light of Amgen’s patronage of Grassley, his harsh rebuke reveals a paradox at the heart of his reputation as a crusader for fortified regulation in the healthcare industries.

Grassley has repeatedly crossed the aisle to propose legislation with democrats aimed at increasing federal oversight of medical products industries. His hardnosed leadership in this usually progressive pursuit has placed him at odds with his conservative colleagues, who unanimously support these industries and the principle that they be permitted to operate in a market unfettered by excessive regulation. Some say that Grassley’s stance jeopardized his re-election in 2010, until he redeemed himself by becoming a strident critic of Obamacare. He warned the public that they were correct to fear that health care reform could lead to the government “pulling the plug on grandma.”

In the meanwhile, Grassley’s opponents on the left suggested that he’s a hypocrite even with respect to Big Pharma because he wrote the Part D prescription drug benefit and the Medicare Advantage bill, which they say was cleverly engineered to result in a $139 billion windfall for the pharmaceutical industry. The pharmaceutical industry mysteriously not only doesn’t advertise against him, as they do other adversaries in Congress, but they continue to make generous campaign contributions to him. Grassley’s outspoken censure of conflicts of interest between doctors and the pharmaceutical industry does not seem to influence his personal behavior.

Ethical violations by pharmaceutical and medical device companies are growing as quickly as true innovation and safety records are deteriorating and prices are rising (Applbaum 2009). The drugs/device component of health care costs is rising more quickly than any other, while physicians increasingly rely this form of high tech intervention. Democrats and Republicans agree that the gravest challenge to balancing the US budget is to cut health care costs, and any serious attempt at health care cost containment will have to address this issue. Grassley’s support on the drugs/device issue is crucial to such an effort because he is knowledgeable and widely respected in his party, and because he has a proven track record of working with democrats to pass related legislation.

What moves the 77-year-old Grassley on this issue? It is clear from his actions that he is driven by more than just fiscal pragmatism. The key may lie in his impassioned personal morality and Iowa-style conservatism. Grassley has been winning landslide elections in Iowa since his first senate election in 1980. He is a lifelong farmer—still residing in the county where he grew up. He is also a member of The Fellowship, sometimes called the C Street Family, a secretive organization founded in 1935, reportedly in opposition to FDR’s New Deal. The Family, as Jeff Sharlet explained in his book by that title (2008), is “a political religion that embraces elitism, disdains democracy, and pursues power for its members the better to ‘advance the Kingdom.’” Alongside that of Big Pharma, Sharlet reports on the C Street Family as among the most powerful lobbyists in the country.

Information on Grassley’s background, ethical worldview, and actions as they relate to the broad effort to reduce health care costs and improve medical practices in America might bring fresh insight into what has become a predictable partisan issue. As cost containment moves to the center of thinking about health care reform, we can expect more overlap between right and left political positions and opportunities, therefore, to influence policy at least a little in the directions that most medical anthropologists would find to be desirable.